From the Guidelines
Adult intussusception typically presents with abdominal pain, nausea, vomiting, and changes in bowel habits, and if left untreated, can progress to bowel obstruction, ischemia, and perforation, resulting in peritonitis and sepsis. The symptoms of adult intussusception can be variable and often develop gradually, with the most common symptom being abdominal pain, typically intermittent and crampy in nature, which may worsen over time 1. Nausea and vomiting frequently occur, especially as the condition progresses, and many patients experience changes in bowel habits, including constipation, diarrhea, or alternating between the two. Blood in the stool (either visible or occult) may appear due to mucosal damage at the intussusception site, and some patients develop abdominal distension and may notice a palpable abdominal mass.
According to a recent study published in the World Journal of Emergency Surgery in 2022, intussusception can be classified into antegrade and retrograde types, with the latter being the most common form after laparoscopic Roux-en-Y gastric bypass (LRYGB) 1. The anatomical classification for jejunogastric intussusceptions, proposed by Schackman et al., categorizes the condition into three types: Type I—Afferent loop intussusception (antegrade), Type II—Efferent loop intussusception (retrograde), and Type III—combined form of intussusception.
The management of jejunogastric intussusception could be endoscopic in selected cases, but surgical exploration is recommended due to the high risk of incarceration and strangulation, with a significant increase in mortality if surgical intervention is delayed beyond 48 hours 1. Surgical resection of the invaginated segment is the treatment of choice for avoiding recurrences, and laparoscopy or open surgery can be used, depending on the experience of the surgeon and the setting. Adults with persistent or recurrent abdominal pain, especially with other gastrointestinal symptoms, should seek medical attention promptly for proper evaluation and management, as early diagnosis and treatment can significantly improve outcomes and reduce the risk of complications.
From the Research
Symptoms of Adult Intussusception
- Abdominal pain is a common symptom, reported in 38% of cases 2
- Subacute abdominal pain should be considered as a potential symptom of adult intussusception 3
- Nausea, vomiting, and weakness may also be present 4
- Chronic intermittent abdominal pain that worsens acutely due to complete obstruction is a possible clinical history 4
- Peritonism and raised inflammatory markers may be associated with intussusception 4
Diagnosis and Etiology
- CT scan is the most useful investigative modality to confirm the diagnosis of intussusception 2, 4
- A high index of suspicion is necessary for the operating surgeon when dealing with acute, subacute, or chronic abdominal pain in adults 5
- Almost 90% of adult intussusceptions are secondary to a pathologic condition 5
- Lead point pathology is present in most symptomatic cases presenting as bowel obstruction 6
- Benign or malignant lesions, such as tumors, may be the cause of intussusception 2, 3, 6
Treatment
- Surgery is often the only option in patients who are unstable and show signs of peritonitis 4
- Intestinal resection with immediate anastomosis is a common technique used in the treatment of adult intussusception 3
- Oncologic bowel resection is usually performed due to the association with lead point pathology 6